Network Adequacy and Access Analyst
About The Position
This position works with other departments and providers to comply with Timely Access standards and regulatory reporting requirements. The Analyst oversees Timely Access Plan activities, ensures adherence to applicable regulations, and reports outcomes to the Director of Customer Experience. The role works across departments to deliver processes, programs, and reporting in a timely and efficient manner, consistent with CHG policies and procedures and applicable state and federal regulations, including CMS, DHCS, and DMHC. It implements quality strategies that may include initiating and managing provider corrective action plans.
Requirements
- Bachelor's degree.
- Knowledge of DMHC and DHCS Access and Availability Standards and methodology.
- Experience with corrective action plan monitoring and follow-up activities.
- Experience with regulatory audits and meeting deadlines.
- Extensive experience working with providers, management, and executive staff.
- Excellent verbal and written communication skills.
- Strong interpersonal skills.
- Knowledge of regulatory processes and expectations.
- Ability to manage multiple projects at any given time.
- Ability to deal with sudden and upcoming changes and deadlines.
Responsibilities
- Execute the DMHC Timely Access and Availability Program, including annual year-over-year analysis and lessons learned.
- Conduct PAAS, ensuring that all steps of the DMHC methodology are followed, and update provider contact information for PAAS.
- Execute the DHCS 274 File Timely Access and Availability Program quarterly.
- Execute the annual Pre-Natal Timely Access and Availability Program, including secret shopping.
- Follow up on corrective action plans and remeasure non-compliant and trending providers.
- Own Timely Access policies and procedures and update Timely Access BPGs.
- Facilitate Timely Access Work Group meetings.
- Serve as the point of contact for third-party vendor activities, including contract renewal, validation, and file uploads.
- Prepare narratives for Contact Lists and ANPRs.
- Oversee the progress and completion of Timely Access report deliverables and ensure their accuracy, including the Grievance Template, Contact Lists, and External Vendor Validation Report.
- Communicate and work with the Compliance Department to research, investigate, or implement Timely Access updates and communications from regulators.
- Analyze and trend access-related grievances and inquiries, identifying opportunities for provider retraining.
- Analyze referral patterns to identify opportunities to optimize distribution.
- Identify opportunities to add PCPs, specialists, ancillary providers, and NPMH providers.
- Prepare provider and member newsletter articles about Timely Access standards and other reminders.
- Conduct onboarding and ongoing training for staff and providers regarding appointment availability standards.
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What This Job Offers
Job Type
Full-time
